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  Last Updated on 07/13/2018

A Pain in the Ear: Ear Infections in Young Children


by Teri Brown for iParenting Magazine @ www.parentingstages.com Caregiver holding child who is holding and admiring her new little kitten.


Babies and toddlers get colds all the time. The worst symptoms of an average cold last just a few days and then taper off. But what if your child begins tugging at his ear, has trouble sleeping and seems more irritable than usual? Chances are your child has developed an ear infection.


According to the American Academy of Family Physicians, more than three out of four children will have at least one ear infection by their third birthday. If left untreated, these infections can lead to permanent hearing loss.


Ear Infections 101
Exactly what is an ear infection and how do you get them? Your ear contains three main parts: the outer or visible ear, the middle ear and the inner ear.


An ear infection, or acute otitis media as it is also called, is when the middle ear, a grape-sized space behind the ear drum, becomes filled with fluid that would normally drain out. Because of unusually high amounts of liquid or inflammation due to a cold or other reasons, however, it does not drain properly.


The Eustachian tube is a small tube that leads to the back of the throat. This is the part that generally becomes clogged. One reason children may be so susceptible to ear infections is that their Eustachian tubes are much shorter than those of an adult.


Trina Strahl, a homemaker from Beaverton, Ore., had no idea she was going to become an expert on ear infections, but that is exactly what happened when her son ended up with a series of chronic infections. "My son had several dozen over a period of 14 months," says Strahl. "He was on medication more than he was off."


Strahl became used to the symptoms that signaled another infection fever, intense crying, night waking, listlessness and digging at his ears. "Eventually, this was routine behavior," says Strahl. "Toward the end, he had become resistant to so many medications, they no longer cleared the fluid from his ears, and he was diagnosed with a chronic infection."


According to Dr. James Thomsen, a specialist in otolaryngology for Children's Healthcare of Atlanta and Pediatric Ear, Nose & Throat of Atlanta, the most common symptoms of ear infection in children are:


  • Ear pain or pulling at the ears;

  • Fever;

  • A temporary decrease in hearing;

  • Fussiness or not being able to sleep;

  • Vomiting or diarrhea;

  • Lack of appetite;

  • Pus draining from the ear.


Other Causes
Though ear infections are the most common cause of ear pain, your child's ears may hurt for reasons other than a typical middle ear infection, such as an infection of the ear canal skin (sometimes known as swimmer's ear), a sore throat or teething or sore gums.


The causes of ear infections vary, but there are high-risk groups that are more likely to develop ear infections than others. "Upper respiratory infections are one common cause of ear infections," says Dr. Thomsen. "However, exposure to smoke, attending a large group daycare and lying down while drinking a bottle will also increase your child's risks."


Other risk factors include:


  • Previous ear infections, particularly if the infections occurred before the child's first birthday;

  • A family history of ear infections;

  • Being premature or a low birth weight;

  • Being a boy (boys tend to have more middle ear infections than girls);

  • Frequent colds or other infections;

  • Taking a bottle to bed.


Diagnosis and Treatment
Because a small child's language hasn't developed to the point of being able to tell you the where he hurts, diagnosis is generally done by a doctor who can look in your child's ear with an instrument called an otoscope. The doctor will inspect the outer ear and the eardrum, searching for inflammation, which indicates an infection. If it is found, you and your pediatrician will then decide on a method of treatment.


"Your child's doctor will talk with you about specific care for your child," says Dr. Thomsen. These might include giving acetaminophen (Tylenol, Tempra, Panadol) for pain and fever. Thomsen suggests that you ask your child's doctor how much of this type of medicine to give. Other methods of treatment your doctor may suggest are: encouraging your child to drink plenty of fluids, avoid exposing your child to cigarette smoke, not allowing your child to take a bottle to bed and being consistent in giving your child the antibiotic your doctor prescribes.


Many ear infections resolve spontaneously when the Eustachian tube begins to function normally again. Controlling the more painful symptoms of ear infections with acetaminophen or topical anesthetics is generally helpful in making your child more comfortable.


Antibiotics are typically used for five to 10 days if the healthcare provider thinks the child has acute otitis media. Because many doctors are mindful of the amount of antibiotics they give, some experts have advocated "watchful waiting" for children over 2 years of age, a strategy in which antibiotics are not given unless there is no improvement in 48 to 72 hours.


If your child has recurring ear infections you may want to seek out a specialist. An otolaryngologist, also known as an ENT specialist (Ear Nose Throat doctor), will determine if infections are causing permanent damage to your child's hearing. If this is the case, your doctor may suggest tubes.


For Strahl, the trauma of the surgery was minimized by how efficiently it was done and by the long-term effects. "He screamed when we gave him to the surgeon, and we felt horrible," says Strahl. She went to call her mother, and before she knew it they were bringing him back to her. "Frankly, I fought tubes from the beginning, but wish I had taken that approach more quickly after the immediate relief it brought," she says.


To many parents, ear tubes are something to be avoided at all cost, but others find, as Strahl did, that the relief they bring is far better than constantly struggling with the reoccurrence of infections.


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About the Author: Teri Brown is an iParenting contributing writer based in Portland, Ore.





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